There were strides during the 1990s toward balancing primary care with sub-specialty fees through recognition by and negotiations with managed care organizations (MCOs). Most of the gains were lost as the MCOs consolidated and Medicare and Medicaid became larger players as the population has aged and the economy deteriorated. Now MCOs use fees approaching Medicare (CMS). Primary care docs had better change the Medicare reimbursement system by gaining a solid foot-hole at the national reimbursement negotiating table.

People are leaving the U.S for many elective specialty procedures due to their overvaluation.

Specialist-PCP Hourly Earnings Under MFS

Read This First! Why Did We Develop This Site?

This site has been developed - see here for our backgrounds - to help primary care physicians and other interested individuals obtain verifiable background from reputable sources on:

The evolution and structure of the US' medical payment system.

How it came to devalue primary care and favor specialty services.

How that has translated to lower quality care at far greater expense in the US.

We believe the overwhelming majority of American primary care physicians are deeply frustrated with the differences in how primary and specialty care are valued by the current system, and the havoc that system has wrought throughout health care and the nation.

The first step to remedying this situation is for the primary care medical societies to visibly and loudly withdraw from participation in the RUC, de-legitimizing the process.

That said, this effort is most decidedly NOT primarily about getting primary care physicians more money, but bringing our health system back into homeostasis.

Together, perhaps we can facilitate a process to replace the RUC with a more balanced, independent advisory panel to the Centers for Medicare and Medicaid Services (CMS).

Then the next step would be to urge replacement of the current, highly jiggered reimbursement methodology, the Resource-Based Relative Value Scale (RBRVS), with another approach that is more modern, enlightened and focused on value. We believe that a core principle of a revised payment system is payment parity for management of complexity.

This is likely to be a process that takes time, so we'll update this site daily to reflect the latest information. Please visit often to stay in touch. And if you think this is important and worthwhile, please pass this site along to your colleagues.